How did the COVID-19 pandemic affect the management of patients with cancer? What is the impact of anti-cancer medications on the immune response to the COVID-19 vaccinations?.
Authors: Mahmoud Abdelsalam, Maged Salem, Alexander McPherson, Nizar Abdel-Samad, Pierre Obrien, Laura Ross, Rana Sughayar, Mrudula Avileli
Journal: Journal of Clinical Oncology (2023)

e24193 Background: This study had two objectives: To assess the impact of the COVID-19 pandemic on cancer patients’ management. To determine the impact of cancer types and anti-cancer medications on the immune response to COVID-19 vaccinations. Methods: Cancer patients at the Moncton Hospital, Oncology/Hematology Clinic, were invited to voluntarily complete a survey about the date of their cancer diagnosis, treatment, the impact of the COVID-19 pandemic on their health, and to complete a prepared list of possible side effects that they experienced after receiving any of the COVID-19 vaccines. Participants, who had received at least two doses of any COVID-19 vaccine, were given the option to consent to a sub-study to provide a blood sample to check their antibody response to the COVID-19 vaccination. Blood samples were collected at least 4 weeks after the second dose of a primary vaccine series, or at least 2 weeks after any booster dose. Samples were sent to the Dr. Georges-L.-Dumont University Hospital lab to be analyzed. Data was collected regarding the type of treatment (chemotherapy, immunotherapy, targeted therapy, hormonal therapy, radiation therapy, or a combination of these therapies). Analysis of the data was done using SPSS program. Results: 178 patients completed the survey. 117 patients had solid tumors, and 61 had a hematological malignancy. The mean age was 65.75 (range 31-90) years and 45.5% were males. 62.3% either had a high school diploma or a graduate degree. When asked if their anxiety about their health increased due to the pandemic, 57.8% reported that their anxiety level has moderately or somewhat increased. Similarly, around 70% responded that their stress levels moderately or somewhat increased due to the pandemic. Only 7.3% of patients mentioned that they had delays in diagnosis, and only 2.8% had changes in their treatment, however, around 30% had their appointments changed into phone appointments as a result of the pandemic. Only 4% reported a loss of job due to the pandemic, and 11.2% reported financial stress. Cross tabulations were done between type of cancer and results of the COVID-19 antibody test and type of treatment and results of the COVID-19 antibody test. Results showed that the type of treatment that the patient was receiving has no impact on the production of COVID-19 antibodies. However, antibodies after COVID-19 vaccination were not detected in 20.5% (10/49) of patients with hematological malignancies compared to 3.6% (3/82) of patients with solid tumors. This difference was statistically significant (p = 0.001). Conclusions: The pandemic affected Cancer patients in terms of increasing their anxiety and stress levels. The production of antibodies after COVID-19 vaccinations was significantly decreased in patients with hematological malignancies.